Quick Model of the Predicted Spread of the Corona Virus

To satisfy my own curiosity, I created a simple model of the multigenerational spread of the CoronaVirus. I'm not an expert on public health so I'm not certain of the assumptions and process of a spreading virus but I know the mathematics is correct. 

Anyway, here's a snapshot of a table based on the following assumptions:

• Generational disease spread originating from one person over 11 generations. (I have no idea if 11 generations is reasonable, but I wanted to provide some sense of how widely the disease could spread.) 
• Each infected person spreads the disease to 3.8 other people. 
• Mortality rate is .02 (2% or crude rate of 2000 per 100,000)
• I guessed that it would take 36 hours for each person to spread the disease to the 3.8 other people. I don't take my timescale all that seriously but it provides some sense of how fast a disease could spread.

The table below shows the spread from single origination point and from 50 origination points. The number of days that it would take to generate these numbers based on my timescale assumption is about 17 days. (These tables have been updated. The death rate in my original tables was .03 not .02. These tables have a death rate of .02.)

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	4	14	55	209	792	3,011	11,442	43,478	165,216	627,821	2,385,721
Running total infected	1	5	19	74	283	1,075	4,086	15,527	59,005	224,221	852,043	3,237,763
Total deaths	0	0	0	1	6	21	82	311	1,180	4,484	17,041	64,755
Multiple Origination Points Infected	50	190	722	2,744	10,426	39,618	150,547	572,078	2,173,896	8,260,805	31,391,059	119,286,025
Running total infected	50	240	962	3,706	14,131	53,749	204,296	776,374	2,950,270	11,211,075	42,602,134	161,888,159
Total deaths	1	5	19	74	283	1,075	4,086	15,527	59,005	224,221	852,043	3,237,763

I have to admit, I gasped when I saw these numbers and thought, I hope this isn't the case. But if the government takes action to stem the infection rate from 3.8 to 2, here's what you get:

Generation	0	1	2	3	4	5	6	7	8	9	10	11
Number infected in Generation	1	2	4	8	16	32	64	128	256	512	1,024	2,048
Running total infected	1	3	7	15	31	63	127	255	511	1,023	2,047	4,095
Total deaths	0	0	0	0	1	1	3	5	10	20	41	82
Multiple Origination Points Infected	50	100	200	400	800	1,600	3,200	6,400	12,800	25,600	51,200	102,400
Running total infected	50	150	350	750	1,550	3,150	6,350	12,750	25,550	51,150	102,350	204,750
Total deaths	1	3	7	15	31	63	127	255	511	1,023	2,047	4,095

The situation becomes far, far more manageable. In addition, the actions the government should take should reduce the number of generations the virus is allowed to spread to others. 

Having seen these numbers, it makes sense to me why South Korea is doing mass testing. The faster you can get infected people out of the environment where they can infect other people, the more manageable the epidemic becomes. In addition, this suggests that barriers and changes in people's behavior to slow the spread of the virus would significantly assist in stemming epidemic.

What Should You Do to Protect Yourself, Your Loved Ones and Your Fellow Citizens?

I prefer not to provide anyone with advice regarding what you should do. However, I'll happy to provide you with expert resources. So ...

Here's the CDC website for the CoronaVirus: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Here's the website for the National Institute of Health: https://www.nih.gov/health-information/coronavirus 

My Comments Regarding the Trump Administration

Now, let's see if in the US, the Trump Administration is able to get it's act together. That news conference on 26 Feb 2020 was not all that reassuring. It was clear that Trump himself is completely clueless about the situation he and his administration are facing and what to do about it. Putting Pence at the head of the effort wasn't reassuring at all. As Governor of Indiana, Pence's policies lead to an outbreak of HIV in southern Indiana. And it took Pence far too long to respond and take actions that addressed the epidemic.(https://www.washingtonpost.com/politics/2020/02/27/mike-pence-hiv-indiana/) 

Let us all continue to monitor the situation going forward.

I'll admit that I have an intense dislike of Trump and the growing group of servile sycophants that surround him. This Administration is corrupt and incompetent, and headed by someone who requires obsequiousness, but careless nothing about competence and truth. 

My opinion has only been reinforced by the Trump Administration's statement that all information, interviews and and statements regarding the CoronaVirus must be cleared through Pence and thus filtered through the administration. In other words, the Administration just muzzled Dr. Anthony Fauci and others. This should scare everyone. Public health should never be politicized, but it appears that it now has. 

I can admit to you that I didn't like the Bush Administration either for a whole host of reasons beginning with lying to get the US into a war with Iraq. But, I can say when it came to concerns about public health, both nationally and internationally, they were not all that bad. 

I feel that I give Administrations credit where credit is due and criticize them when their actions and policies do damage. And from what I have seen, Trump and his Administration has done little to make things better and done lots of damage. And things are only getting worse.


Here's an article from the Washington Post regarding a newly filed whistle blower complaint: https://www.washingtonpost.com/health/2020/02/27/us-workers-without-protective-gear-assisted-coronavirus-evacuees-hhs-whistleblower-says/

Public Health Alert -- Foreign Policy: Trump Has Sabotaged America’s Coronavirus Response by Laurie Garrett, January 31, 2020

If you don't know Laurie Garrett and her works regarding disease transmission, epidemic and public health policy, you should. Her expertise in these areas is renown and she knows more about these areas than nearly every practicing physician. I venture to guess that if you look in the library of many physicians, you'll probably see at least one or more of her books. If you have any interest in public health, particularly when it comes to the spread of disease, then I suggest that you read one or more of her books. 

Here is the link to Laurie Garrett's article in Foreign Policy: https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-states-public-health-emergency-response/

 Trump Has Sabotaged America’s Coronavirus Response

Under President Obama, the US infrastructure and ability to respond to pandemics was unparalleled. It took years to create the organizational and management structures and put the systems put in place to manage a pandemic and protect Americans as well as others throughout the world. Trump on the other hand destroyed everything that President Obama had created for addressing pandemics, but has gone further to downgrade the capabilities of our public health systems including the Centers for Disease Control (CDC). 

Here are a few quotes from her article:

• In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure.
• In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.
• In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10.

Comparing the CoronaVirus to Something Similar that We Know and Have Experienced

As a means of comparison, the death rate from those infected by common and yearly influenza virus strains is about 1 in 1000. (.1%) In a recent interview, Laurie Garrett stated that the death rate for the Coronavirus is at 2 in 100 (2% or crude rate of 2000 in 100,000) and in some places in China, some have reported a death rate at closer to 6 in 100 (6%). The death rate in the influenza pandemic of 1918 was something on the order of 2 to 3 in 100 (2 to 3%). And if you have don't any sense of just how bad that pandemic was, there are many books and articles (printed and online) that discuss it and several documentaries that are available. One of the complicating factors that assisted the spread of the virus. This outbreak occurred during World War I and as part of US policy, the Federal Government did little or nothing to respond to stem the spread of the virus. The rationale was that the lack of a strong public health response was to continue to maintain the US's war fighting capability. It was feared that public health measures result in the reduction in war materials production and in the recruitment and training of troops. Also, there was concern that a public health response could create panic, thus also affecting the ability to prosecute the war. In fact the Federal Government actively suppressed information about the epidemic and the measures to take to prevent its spread.

There's a great deal of controversy regarding whether the actions or lack of action taken by the Federal Government was this was a good idea. The lack of a public health response created a situation where replacement troops from the US infected troops already in the field, thus reducing unit combat effectiveness and leading to field hospitals being overloaded and caregivers over taxed. Also, the lack of information and direction from the Federal Government created fear and panic. Providing the information and direction on ways to suppress the spread of the virus would have actually helped the war effort.

Finally, if you look at the responses by the Federal Government to the possibility of a Coronavirus epidemic hitting the US, the responses are uncoordinated, scattered and filled with both good and misinformation. The "head in the sand" approach taken by the White House and the President ("everything is fine, nothing to worry about here, the virus will disappear by April ...") is at odds with the statements from the CDC and the World Health Organization about the likely spread of the Coronavirus to the US.

What the US does to deal with this epidemic will be important. In 1918, the actions the US took actually aided the spread of the virus around the world. What the US did with other organizations such as Doctors without Borders (I should note that I make a monthly donation to Médecins Sans Frontières, Doctors without Borders) in 2014 to stem and contain the spread of the Ebola virus was important. What the US does in response to stem the spread of the Coronavirus will be important ... for better or for worse. 

Deaths from Despair Part 3: Across US Metropolitan Areas

When I was analyzing suicide data, I subdivided the data by a variety of factors, both by single factors and multiple factors. One of those factors that proved itself as something of interest was the metropolitan area where the suicide victim resided. What I found was that the smaller the metropolitan area, the higher the suicide rate relative to the other metropolitan areas in each year. This was particularly true in more recent years. Since, death by suicide is one of measurements included in death from despair it makes sense to examine this data using as a factor in the analysis, metropolitan area. 

The figure below shows the death rate from despair for the six 2013 US metropolitan areas. The death rate for all metropolitan areas is shown as a dashed line.

Several things jump out from the figure above:

• The rate of death from despair from 1999 to 2018 has doubled and no metropolitan area has been spared.
• Death rates dropped from 2017 to 2018 except for large metropolitan and noncore areas.
• In 1999 large central metropolitan areas had the highest rate of death from despair. However, by 2018, they had the lowest rate. 
• In 1999 large fringe metropolitan areas had the lowest rate of deaths from despair while the other metropolitan areas were more tightly bunched.
• Over time, two clusters have developed: 1) large metropolitan areas and 2) medium-small metropolitan areas. Large metropolitan areas fall under the overall rate while the medium-small metropolitan areas are over the overall rate.

The figure below shows the year to year trends for large and medium-small metropolitan areas. And the figure that follows shows the year to year differences between the rates of death from despair for medium-small and the large metropolitan areas. 

These two figures show that while death rates from despair have increased dramatically in both clusters, the gap between large and medium-small metropolitan areas has grown over time with more deaths from despair occurring more frequently in medium-small metropolitan areas than in large metropolitan areas.

One of the reasons for the difference in rates of death may in part be due to the fact that economic opportunities have continued to shift to large metropolitan areas and economic opportunities continue to diminish in medium-small areas. That may help explain the difference we're seeing between large and medium-small areas. However, deaths from despair continue to increase in all metropolitan areas at an alarming rate. If economic opportunity were the explanation, then one would expect large metropolitan areas to be showing a dramatically lower rate of increase or no increase at all or maybe even a decrease in the rate of death from despair, but that's not what we're seeing. 

Deaths from despair have been increasing, but they have been increasing at a faster pace in medium-small than in large metropolitan areas in the US. 

Deaths from Despair Part 2: Gender as a Factor

Before I get into the data, I want to mention that the 2018 data has been loaded on the CDC's Wonder database (https://wonder.cdc.gov). I'll update some of recent findings using this new data. The new data has changed my projections for 2025. They're less dire than my earlier projections, nevertheless, they're still unacceptable. I'll discuss the updated projections at the end of this article.

My approach in this series of articles is to first consider single factor comparisons before I drill down into multi-factor comparisons and trend analysis. In this article I focus on gender. In later articles I'll focus on age, race, Hispanic, size of the community, etc. I'll also divide the data into two groups: 1) drug and alcohol deaths and 2) suicides, and analyze the data by the same list of single factors used to analyze deaths from despair. After the single factor analysis, I'll focus on multi-factor comparisons. 

Deaths from Despair: Gender Comparisons

From my analysis of suicide and drug-overdose deaths data, I found that there were clear differences between men and women. You'll note that there are clear gender differences when it comes to deaths from despair as you'll note in the figures below.

In terms of the number of deaths per 100,00 (crude rate), men die in much greater numbers than women. The difference is stark. Furthermore, the trend lines are decidedly different. In both cases, the trend is upwards, but with women the curve is linear, meaning the rate remains the same from year to year. However, the trend line for men is curvilinear, meaning that the rate of increase is accelerating.

One positive things to note is that in 2018 for both men and women, the number of deaths dropped from 2017. However, as I noted before, the number of drug overdose deaths for 2017 jumped dramatically from 2016, well beyond my worst case expectations. The hope is that the 2018 results suggest a downward trend, but it may be that the 2018 suggest only a slowing of the rate of increase, not a change in direction. A signal of a change in direction would be that the number of deaths in 2018 was less than 2016 and that's not the case.

Updates to Trend Lines

I want to mention that I have updated the trend line for Total (men and women combined) as a result of the addition of the 2018 data point. Although a 3rd order curve is a slightly better fit, the 2nd order curve better accounts for the addition of the 2018 data. And as you'll note has a lower acceleration rate.

Number of Deaths

The figure below shows the actual number of deaths for women, men and total number. 

The figure above puts the problem the US faces in stark terms. Yes, there was a drop in the total number of deaths from despair from 2017 to 2018, but any way you look at it nearly 157,000 (total) deaths from despair each year is unacceptable as well as all of the unnecessary deaths from despair during this 20 year period from 1999 to 2018. 

What's Going on in America? Why is this happening?

I've started reading the book by Kristof and WuDunn, Tightrope (2020). There are a couple of quotes from their book that I believe are applicable here:

• "Gallup found that Americans are among the most stressed populations in the world, tied with Iranians and even more stressed than Venezuelans." 
• "America now lags behind its peer countries in health care and high-school graduation rates while suffering greater violence, poverty and addiction."

The numbers and the trends provide further support to these quotes. And I believe help explain why these numbers are so high. 

I'll discuss more of the possible reasons why Americans die with such frequency from despair in later articles. 

Gender Differences

Women may be dying less from despair than men -- about 1/3 as many per year. But approximately 45,000 deaths per year in 2017 and 2018 is a number that should be of great concern. And then one examines the number of men dying from despair. Yes, women do seem to be more resilient, but there are levels of stress can overcome even the most resilient.

The nearly 112,000 men dying in the last two years should be significant concern. In contrast approximately 115,000 Americans died each year as a result of conflict in World War II, the bloodiest war in world history. For America the time for that war was just over three and a half years. And here we're seeing over 20 years each year deaths in the range of what you would expect in a full scale war. And these are avoidable deaths. 

Projections to 2025

The following two figures show my current projections from 2019 to 2025. 

These projections are based on my current trend lines as shown in the first figure. 

I have the greatest confidence in the projected trend line for women. Based on everything that we have seen, deaths from despair for women will continue to increase the steady pace shown in the figures. I have less confidence in the trend for men. Accelerated growth is difficult to project into the future.

The trend line to 2025 combining men and women (total) that includes the 2018 data shows about 100,000 fewer deaths projected for 2025 than my earlier projection. That earlier figure is shown below.

217,000 deaths instead of 331,000 is over one third fewer, but 217,000 deaths is still a staggering number of deaths from despair. But even if the number of per year deaths remained the same from year to year from 2018, 157,000 total deaths each year is a staggering number of avoidable deaths, in this case, from despair.

Deaths from Despair: Part 1A

Predicting the future outcomes using data from the past has its limits. If the future is "written in stone," then the stones are rarely if ever available when one is doing prognostication. This is especially true when one is attempting to prognosticate what humans will do in the future. 

Scientists creating models of climate change have it somewhat "easier" than psychologist and sociologist when it comes to creating more accurate predictive models. Their models are based on more knowable things such as physics and chemistry. And even they have gotten things wrong although over the decades their models have become much more precise as more data has been collected enabling them to adjust their models and also adding more variables to their models. Finally, the addition of greater and greater super computing power hasn't hurt either. There are times that I envy them. But then I take a look at what they're predicting, knowing that their predictions are firmly based, and my blood runs cold. I haven't yet broken into a cold sweat, but I've come close. These models are flashing red warning signals. 

And here's something more to consider, one area where these models have not quite been matching up with the actual data is in the timing of events. It appears that the predicted changes are coming at a much faster rate than originally predicted. This seems even to be the case with the more recent models.

But I digress ... 

Allow me to get the points I wanted to share. 

A Clarification

I wrote what I did above in order to point out an apparent discrepancy between the drug overdose deaths model and the deaths from despair in their predictions for the crude rates and number of deaths from 2017 to 2025. As it turns out the prediction crude rate and number of deaths from drug overdoses are larger in 2025 than the deaths from despair. 

Predicted Deaths from Drug Overdoses

Predicted Deaths from Despair

What is clear is the drug overdoses has comprised the major portion of deaths from despair. Nevertheless, why does the model for drug overdoses predict a higher number of deaths than the model for deaths of despair.

The problem falls largely with trying to fit a model to the existing data that best explains and enables one to predict the future. Clearly the best model for the drug overdose deaths was the fourth order model that showed greater acceleration than the third order model for the deaths from despair. Deaths from despair include two components suicides and alcohol related deaths that have not been increasing at the rate of drug overdose deaths. Thus when it comes to the actual data, deaths from despair is shifted upwards overall from 1999 to 2017 as you can see, but not accelerating as quickly as drug overdose deaths. Thus the seeming impossibility between the predictions for drug overdoses greater than deaths from despair for 2018 to 2025.

Nevertheless, what is more important is the clarity of the message that both curves are accelerating, meaning that the rate of change is expected to increase year to year. And the rate of change of the curves does not bode well for the future. The hope is that the 1) the rate of change will stop increasing and 2) that soon an inflection point will occur and the curves will begin to point downward. These curves provide a warning namely that based on current data predicting that the future doesn't look promising. I believe that is the major takeaway. Let's hope that these predictions are wrong.

As a side note, I wish the predictions regarding climate change are wrong ... but they're not. And we need to do something about it. But I digress ...

Deaths from Despair Part 1

I became interested in deaths from despair as a result of two articles published in the New York Times in 2018 of summaries of the research from Case and Deaton on the raising rate of deaths from despair particularly among US Whites. Here are links to those articles:

• https://www.nytimes.com/2015/11/03/insider/more-white-men-die-from-suicide-and-substance-abuse-why.html?searchResultPosition=2
• https://www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-aged-white-americans-study-finds.html?searchResultPosition=3

My interest has been rekindled largely by the recent reports that US life expectancy had dropped over a three year period. Here's a link to one of those articles from the Washington Post: https://www.washingtonpost.com/health/theres-something-terribly-wrong-americans-are-dying-young-at-alarming-rates/2019/11/25/d88b28ec-0d6a-11ea-8397-a955cd542d00_story.html

I've already analyzed data obtained from CDC's Wonder (https://wonder.cdc.gov) database on suicides and drug overdose deaths. I've discussed them in this blog. In addition, I've collected from Wonder on alcohol-related deaths. Combined, these three categories have been defined as deaths resulting from despair as defined by Case and Deaton of Princeton University (Mortality and Morbidity in the 21st Century, 2017) and by a follow-up study to Case and Deaton's research by the Senate Joint Economic Committee (Long-Term Trends in Deaths of Despair). The Senate Report defined alcohol related deaths somewhat differently than Case and Deaton, nevertheless, the numbers from both studies tell the same story. 

A Series on Deaths from Despair

I've decided to do a series of articles focusing on different aspects of Deaths from Despair. All indications are that the US is in trouble and deaths from despair provide strong indications of the level of that trouble. 

My interest in this area has additionally been motivated by my curiosity of those who follow and revere Donald Trump. It seems that so many of them see Trump as a kind of savior, someone who will magically lift them out of their perils. What I have also found in my analysis of suicides and drug overdose deaths, that those people who seem to cling most strongly to Trump are the ones most likely to die an untimely death by suicide or a drug overdose. The sad part is that these people are clearly in need, clearly hurting but as anyone who has been paying attention: Trump like all con-men will promise them anything and everything, but takes everything he can for himself, his family members and his cronies. Yet Trump's followers continue to revere him, remain enthralled and part of his cult of personality in spite of the fact that Trump has given them nothing but his vitriol to cling to. 

(As a side note, my late cousin was the leader of a cult, the Living Word Fellowship, so I have some understanding how cult leaders operate: how they gather and hold on to their membership while finding every way possible to exploit them. I have been completely amazed that so many of these abused people have continued to remain in the cult. Even the so many of the ones who have left continue to focus much of their energy and attention on the cult and the cult leaders. Somehow the cult fulfills a need or needs in its followers that locks them in. 

Since I'm related to the cult leader, I understand the viewpoint of the leader of the cult. I don't have a clear understanding of those who comprise the membership, but I have seen, heard and read snippets from followers and former followers. I don't like what I've learned. These are people who have been exploited and brutalized, yet they come back from more. I don't believe I'll ever understand them.)

In this article, I'll focus on one or two areas related to deaths from despair. Later articles on this topic will focus on one or two areas of interest with deep dives into the data and what current data can project for the future.

Overview: Deaths from Despair 1999 to 2017 

The figure below shows the number of deaths from despair (combined: suicides, drug overdoses and alcohol related) from 1999 to 2017 obtained from Wonder. 

The best fit trend line can be found in upper left of the chart. Note that this is a 3rd order increasing curve. This is the equation used to predict future outcomes.

As mentioned in an earlier article, CDC announced that drug overdose deaths for 2018 dropped from 2017. However, 2018 data has not been loaded on to Wonder. As I have noted in an earlier article, the number of deaths can change from the announcement to their inclusion into Wonder. For now, I'll use only that data currently available in Wonder. When the numbers from 2018 have been included into Wonder, I'll include that data and make any necessary revisions to my analysis.

One of the things I noted in both studies, is that both studies use normalized data such as crude rates (number per 100,000 population) and percentages. And this makes complete sense when you're comparing one year to the next and in studies such as these. However, when you look at the raw numbers of deaths from despair, the scale of the problem (or problems) we're confronting hits home as shown in the figure below. 

From 1999 to 2017 the number of deaths has risen from nearly 68,000 to nearly 157,000 people living in the US. And over the last 10 year, the number of deaths from despair totals over 1.2 million people. The US crossed into over 100,000 deaths from despair per year in 2009. The world was in the middle of the financial crisis in 2009 and the economy was in downward spiral. An high number of deaths from despair would not be unexpected, but one would hope that as the economy got better, the number of deaths from despair would start to drop. Instead they continued to rise and at an accelerating rate due largely to the opioid addiction crisis in which the US has found itself locked in battle. However, having said this, suicides and alcohol related deaths have also continued to rise, although at a lower rate of increase than drug overdose deaths. (Interestingly enough, drug overdoses as the manner of death in suicides has decreased over the last several years while death by firearm and suffocation/strangulation have continued to increase.)

Projections to 2025

The figure below shows a projects a continuing increase in the crude rate of deaths from despair to 2025. 

The projection of the number of deaths to 2025 puts the problem in clear and stark terms as shown in the figure below.

One can only hope that somehow the staggering rate of increase will be at least slowed, if not stopped. The death rate and numbers for 2017 are unacceptable and suggest that the US has a serious social problem in its midst that needs to be addressed. But a country the size of the US with over 300,000 deaths from despair in a single year with 2.2 million deaths in the last 10 years could only be described as catastrophic.